Alcohol

Alcohol Use Disorder (AUD) is a chronic relapsing condition characterized by impaired control over alcohol consumption despite harmful physical, psychological, or social consequences. In individuals with physiological dependence, sudden reduction or cessation of alcohol intake leads to alcohol withdrawal syndrome, which ranges from mild symptoms to severe life-threatening complications such as seizures and delirium tremens.

Alcohol detoxification involves supervised medical management aimed at preventing withdrawal complications, reducing mortality risk, and preparing patients for long-term rehabilitation and relapse prevention.

Risk Factors

• Chronic heavy alcohol consumption

• Previous alcohol withdrawal episodes

• History of withdrawal seizures or delirium tremens

• Coexisting psychiatric illness

• Liver disease or chronic medical illness

• Malnutrition

• Older age

• Concurrent substance use

• Poor social support

• Abrupt cessation after prolonged intake

Signs and Symptoms

Early Withdrawal Symptoms (6–24 hours)

• Insomnia

• Tremors

• Anxiety

• Chills

• Sweating

• Headache

• Nausea or vomiting

• Palpitations

Moderate Withdrawal

• Increased blood pressure

• Tachycardia

• Irritability

• Restlessness

• Mild confusion

Severe Withdrawal

• Seizures

• Hallucinations

• Severe agitation

• Delirium Tremens

Diagnostic Criteria

Diagnosis is clinical and based on:

Recent reduction or cessation of prolonged alcohol use accompanied by ≥2 of the following:

• Insomnia

• Tremors

• Anxiety

• Autonomic hyperactivity

• Nausea or vomiting

• Psychomotor agitation

• Transient hallucinations

• Seizures

Symptoms must cause clinically significant distress or functional impairment and not be explained by another medical condition.

Investigations

Baseline Laboratory Tests

• Blood glucose level

• Full blood count

• Electrolytes

• Liver function tests

• Renal function tests

• Serum magnesium

• Blood alcohol level

Additional Assessment

• ECG in high-risk patients

• Screening for coexisting infections

• Nutritional assessment

• Mental health evaluation

Management

Management goals include:

• Prevention of severe withdrawal

• Stabilization of vital functions

• Correction of nutritional deficiencies

• Preparation for long-term abstinence

Non-Pharmacological Management

• Support groups encouraging abstinence

• Psychological counselling

• Motivational interviewing

• Family and community support

• Inpatient rehabilitation programs when necessary

• Safe and low-stimulation environment

• Adequate hydration and nutrition

Pharmacological Management

Vitamin Replacement

Chronic alcohol use commonly causes thiamine deficiency leading to neurological complications.

• Thiamine 300 mg IM every 24 hours(for prevention of central nervous system complications)

Benzodiazepine Therapy (Detoxification)

Option 1 – Diazepam Regimen (Inpatient care only)

• Diazepam 10 mg orally every 4–6 hours during first 24 hours

• Gradually reduce dose by 20% over 3–5 days

OR

Option 2 – Chlordiazepoxide Regimen

• Chlordiazepoxide 20–60 mg orally daily in divided doses

• Gradual taper over approximately 1 month

Benzodiazepines reduce:

• Withdrawal severity

• Seizure risk

• Progression to delirium tremens

Relapse Prevention Following Detoxification

Long-term treatment is essential after successful detoxification.

Pharmacotherapy

• Naltrexone 50 mg orally once daily

  • Reduces alcohol craving

  • Decreases relapse risk

Psychosocial Interventions

• Cognitive Behavioural Therapy (CBT)

• Alcohol abstinence programs

• Peer recovery groups

• Behavioral relapse-prevention strategies

Complications

• Withdrawal seizures

• Delirium Tremens

• Wernicke encephalopathy

• Korsakoff syndrome

• Liver cirrhosis

• Cardiomyopathy

• Depression and suicide risk

Prevention

• Screening for harmful alcohol use in primary care

• Early intervention programs

• Public education on alcohol-related harm

• Gradual medically supervised cessation

• Nutritional supplementation in high-risk individuals

• Continuous rehabilitation and follow-up care

Prognosis

Outcomes improve significantly with structured detoxification followed by long-term rehabilitation. Relapse is common without psychosocial support and pharmacologic relapse prevention.

Patient Education

• Alcohol dependence is a treatable medical condition

• Sudden alcohol cessation without supervision may be dangerous

• Medication-assisted detox reduces complications

• Long-term recovery requires behavioural support

• Continued follow-up prevents relapse